title: Hypospadias repair with tubularized incised plate. Is uroflowmetry necessary postoperatively?
abstract: OBJECTIVE
  Hypospadias repair with tubularized incised plate urethroplasty (TIP) produces good cosmesis, but is reported to result in a change in urinary stream postoperatively, with an obstructive pattern. The aim of this retrospective study was to determine whether early uroflowmetry is a good method for diagnosing neourethral stricture.
  
  
  METHODS
  In 126 boys, primary TIP repair was performed between 1999 and 2003. Uroflowmetry was performed in potty-trained boys 2 months' postoperatively (68 boys) and both 2 and 12 months (38 boys) after TIP. Boys with obstructed flow and/or clinical symptoms were calibrated in their neourethra.
  
  
  RESULTS
  Forty-nine percent of the boys with distal hypospadias and 87% of the proximal cases had a flow rate of less than 10 ml/s at uroflowmetry 2 months after TIP, but only 12/126 boys (10%) were considered to have a neourethral stricture. There was a spontaneous increase in maximum flow rate between 2 and 12 months after TIP repair both in patients who had been calibrated and in boys in whom no intervention had been performed.
  
  
  CONCLUSIONS
  Early uroflowmetry appears to be unnecessary, as the voiding history appears to be just as good at alerting a suspicion of urethral stricture after TIP repair. There is a spontaneous normalization of the urinary flow in boys after TIP repair, but the need for long-term follow up beyond puberty is great, especially in cases of proximal hypospadias.
authors.affiliation: Department of Pediatric Surgery and Urology, The Queen Silvia Children's Hospital, The Sahlgrenska Academy, SE-416 85 Göteborg, Sweden.
authors.forename: Gundela
authors.initials: G
authors.lastname: Holmdahl
authors.forename: Lena
authors.initials: L
authors.lastname: Karström
authors.forename: Kate
authors.initials: K
authors.lastname: Abrahamsson
authors.forename: Monika
authors.initials: M
authors.lastname: Doroszkiewicz
authors.forename: Ulla
authors.initials: U
authors.lastname: Sillén